Studies

Question 1

Insite I and II

Answer 1

Insite PHase 1

• Superior efficacy SNM vs. SMT
• 3x’s greater QOL
• SNM: 76%
• SMT: 49%
• 6 months

Phase II

• 82% had 50% or greater improvement at 5 years
• 45% Completely continent at 5 years

Question 2

MDT 103

Answer 2

• @5 years: 78% of retention patients has successful outcomes
• Evaluable patients: defined as a subset of subjects for whom both baseline and 5 year data were available
• intent to treat: defined as all implanted study subjects, including those who dropped out and were imputed as no change from baseline

Question 3

Richter (Rosetta) 2017:

Answer 3

• Botox vs SNM
• Only 3 contacts on lead placement vs. now we have 4 contacts which can curve medial to lateral
• age mattered with failure of Botox
• age didn’t matter with SNM the only factor in knowing if it worked was doing a TEST.

Question 4

Yeaw (2009)

Answer 4

• adherence to OAB meds/patients DONT stay on meds
• 72% discontinued OAB meds @6 months
• 82% discontinued OAB meds@12 months

Question 5

Wexner (2010)

Answer 5

• Bowel
• 83% had 50% or greater reduction in weekly incontinent episodes @12 month
• 41% had achieved complete continence @12 month

Question 6

Hull (2013)

Answer 6

• Bowel
• 89% had 50% or greater reduction in weekly incontinent episodes @5 years
• 36% achieved complete continence @5 years
• QOL is significant and sustained in all 4 areas of FIQOL score out of 5 years

Question 7

Chan (2008)

Answer 7

• Anal Sphincter Defect vs No Anal Sphincter defect
• 72% of patients WITHOUT Anal sphincter defect had atleast 50% improvement in weekly incontinent @12 months
• 68.8% of patient with Anal sphincter defect had atleast 50% improvement in weekly incontinent episodes at 12 months

Question 8

Nobrega (2018)

Answer 8

-60% of patient preferred SNM over Botox

Reasons:

• Cystoscopy was surprisingly viewed as more invasive than the tined lead/full implant procedure
• patients repeatedly expressed their desire to avoid the need for learning Clean Intermittent Self Catheterizing of 10-20% chance.
• the need to repeat every 6-12 months

Question 9

Kohli (2009)

Answer 9

• OBGYN should offer SNM if they see refractory OAB patients
• if patients have failed to respond to or experience side effects to 2 or more anticholinergic medications then further evaluation including SNM is recommended.

Question 10

Support for AE after BE:

Answer 10

• 3 studies
• Mdt restrospective study showed 88% of patients who reported inconclusive BE reported successful results after AE
• According to data 42% to 88% of patient have had a successful AE after having an inconclusive BE

Question 11

Burks(2008)

Answer 11

• On average only 2 programmings are needed per patient per year
• Programming is not a burden